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The latest research articles published by International Journal of Bipolar Disorders2015-02-25T00:00:00Z

The influence of life events on first and recurrent admissions in bipolar disorderBackground:
Life events play an important role in the onset and course of bipolar disorder. We will test the influence of life events on first and recurrent admissions in bipolar disorder and their interaction to test the kindling hypothesis.
Methods:
We collected information about life events and admissions across the life span in 51 bipolar patients. We constructed four models to explore the decay of life event effects on admissions. To test their interaction, we used the Andersen-Gill model.
Results:
The relationship between life events and admissions was best described with a model in which the effects of life events gradually decayed by 25% per year. Both life event load and recurrent admissions significantly increased the risk of both first and subsequent admissions. No significant interaction between life event load and number of admissions was found.
Conclusions:
Life events increase the risk of both first and recurrent admissions in bipolar disorder. We found no significant interaction between life events and admissions, but the effect of life events on admissions decreases after the first admission which is in line with the kindling hypothesis.http://www.journalbipolardisorders.com/content/3/1/6
Sanne KemnerNeeltje van HarenFlorian BootsmanMarinus EijkemansRonald VonkAstrid van der SchotWillem NolenManon HillegersInternational Journal of Bipolar Disorders 2015, null:62015-02-25T00:00:00Zdoi:10.1186/s40345-015-0022-4/content/figures/s40345-015-0022-4-toc.gifInternational Journal of Bipolar Disorders2194-7511${item.volume}62015-02-25T00:00:00ZXMLMulti-state models for investigating possible stages leading to bipolar disorderBackground:
It has been proposed that bipolar disorder onsets in a predictable progressive sequence of clinical stages. However, there is some debate in regard to a statistical approach to test this hypothesis. The objective of this paper is to investigate two different analysis strategies to determine the best suited model to assess the longitudinal progression of clinical stages in the development of bipolar disorder.
Methods:
Data previously collected on 229 subjects at high risk of developing bipolar disorder were used for the statistical analysis. We investigate two statistical approaches for analyzing the relationship between the proposed stages of bipolar disorder: 1) the early stages are considered as time-varying covariates affecting the hazard of bipolar disorder in a Cox proportional hazards model, 2) the early stages are explicitly modelled as states in a non-parametric multi-state model.
Results:
We found from the Cox model thatthere was evidence that the hazard of bipolar disorder is increased by the onset of major depressive disorder. From the multi-state model, in high-risk offspring the probability of bipolar disorder by age 29 was estimated as 0.2321. Cumulative incidence functions representing the probability of bipolar disorder given major depressive disorder at or before age 18 were estimated using both approaches and found to be similar.
Conclusions:
Both the Cox model and multi-state model are useful approaches to the modelling of antecedent risk syndromes. They lead to similar cumulative incidence functions but otherwise each method offers a different advantage.http://www.journalbipolardisorders.com/content/3/1/5
Charles Keown-StonemanJulie HorrocksGerarda DarlingtonSarah GooddayPaul GrofAnne DuffyInternational Journal of Bipolar Disorders 2015, null:52015-02-24T12:00:00Zdoi:10.1186/s40345-014-0019-4/content/figures/s40345-014-0019-4-toc.gifInternational Journal of Bipolar Disorders2194-7511${item.volume}52015-02-24T12:00:00ZXMLSwitch to mania after ayahuasca consumption in a man with bipolar disorder: a case reportBackground:
There is an increasing use of ayahuasca for recreational purposes. Furthermore, there is a growing evidence for the antidepressant properties of its components. However, there are no reports on the effects of this substance in the psychiatric setting. Harmaline, one of the main components of ayahuasca, is a selective and reversible MAO-A inhibitor and a serotonin reuptake inhibitor.Case reportWe present the case of a man with bipolar disorder who had a manic episode after an ayahuasca consumption ritual. This patient had had at least one hypomanic episode in the past and is currently depressed. We discuss the diagnostic repercussion of this manic episode.
Conclusion:
There is lack of specificity in the diagnosis of substance-induced mental disorder. The knowledge of the pharmacodynamic properties of ayahuasca consumption allows a more physiopathological approach to the diagnosis of the patient.http://www.journalbipolardisorders.com/content/3/1/4
Alejandro SzmulewiczMarina ValerioJose SmithInternational Journal of Bipolar Disorders 2015, null:42015-02-24T12:00:00Zdoi:10.1186/s40345-014-0020-y/content/figures/s40345-014-0020-y-toc.gifInternational Journal of Bipolar Disorders2194-7511${item.volume}42015-02-24T12:00:00ZXMLImpact of childhood trauma and affective temperament on resilience in bipolar disorderBackground:
The aim of this study was to investigate whether childhood trauma (CT) and affective temperament have an impact on resilience in bipolar patients.
Methods:
One hundred cases with bipolar disorder (BD) diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) were evaluated consecutively in their euthymic period during outpatient follow-up interviews. Diagnostic interviews were done with SCID-I, affective temperament was evaluated with the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire, and resilience was evaluated with the Resilience Scale for Adults (RSA). The presence of CT was determined and measured with the Childhood Trauma Questionnaire (CTQ).
Results:
Among the bipolar patients, it was found that 35 cases (35%) were CT+. Depressive, cyclothymic, and anxious temperament scores were higher in CT+ cases. However, resilience scores were higher in CT− cases. In bipolar patients with and without childhood trauma, the relationship between temperament and resilience appears to be different. A negative relation between sexual abuse, emotional abuse, emotional neglect, and anxious temperament scores and resilience scores was shown in regression analysis.
Conclusions:
CT and affective temperament both have an impact on resilience in bipolar patients.http://www.journalbipolardisorders.com/content/3/1/3
Sermin KesebirBa¿ak ÜnübolElif Tatl¿dil Yaylac¿Duru Gündo¿arHüseyin ÜnübolInternational Journal of Bipolar Disorders 2015, null:32015-02-24T12:00:00Zdoi:10.1186/s40345-015-0023-3/content/figures/s40345-015-0023-3-toc.gifInternational Journal of Bipolar Disorders2194-7511${item.volume}32015-02-24T12:00:00ZXMLBurden, reward, and coping of adult offspring of patients with depression and bipolar disorderBackground:
In previous years, research has focused on the situation of psychiatric patients' minor children. The aims of this qualitative study were to describe the experience of adult children of depressed and bipolar patients, including positive and negative factors as well as coping mechanisms, and to investigate possible predictors of burden in order to identify children in need of professional support.
Methods:
A total of 30 adult children were interviewed using a semi-structured interview. In addition, all children completed the Freiburg Questionnaire of Coping with Disease (Freiburger Fragebogen zur Krankheitsverarbeitung, FKV). Regression analysis indicated the most relevant predictors of burden.
Results:
All (100%) of the children reported emotional burden due to the illness of their parent, 90% suffered from impaired family life, and 77% experienced burden due to the parent's symptoms. Reward (positive experience) was reported regarding the intensification of the parent-child relationship. Linear regression analysis shows predictors for highly burdened children as well as for children who are more prone to maladaptive ways of coping. Higher burden was significantly associated with the child's age, severity of illness of the parent, and specific diagnosis.
Conclusions:
Although some positive aspects of parental affective disorder exist, this study underlines that children primarily suffer from their parent's disorder and that this burden does not stop in adulthood. Providing professional support to adult as well as to minor children of affected individuals should become standard of care in clinical settings.http://www.journalbipolardisorders.com/content/3/1/2
Rita BauerHermann SpiesslMarina HelmbrechtInternational Journal of Bipolar Disorders 2015, null:22015-01-31T12:00:00Zdoi:10.1186/s40345-015-0021-5/content/figures/s40345-015-0021-5-toc.gifInternational Journal of Bipolar Disorders2194-7511${item.volume}22015-01-31T12:00:00ZXMLMore robust evidence for the efficacy of lithium in the long-term treatment of bipolar disorder: should lithium (again) be recommended as the single preferred first-line treatment?With two recent systematic reviews and meta-analyses on the efficacy of lithium compared to placebo and other treatment options, it can now be concluded that lithium is the only drug that has been shown efficacious in the prevention of any mood episodes, manic episodes and depressive episodes in randomised trials not enriched for prior response to and tolerance of lithium. It is argued that lithium should be recommended as the single preferred first-line drug in the long-term treatment of bipolar disorder.http://www.journalbipolardisorders.com/content/3/1/1
Willem NolenInternational Journal of Bipolar Disorders 2015, null:12015-01-31T12:00:00Zdoi:10.1186/s40345-014-0017-6/content/figures/s40345-014-0017-6-toc.gifInternational Journal of Bipolar Disorders2194-7511${item.volume}12015-01-31T12:00:00ZXMLProphylactic lithium treatment and cognitive performance in patients with a long history of bipolar illness: no simple answers in complex disease-treatment interplayCognitive impairment in patients with bipolar disorder (BD) is not restricted to symptomatic phases. It is also present in euthymia. There is evidence of differences in the brain’s structure between bipolar patients and healthy individuals, as well as changes over time in patients. Lithium constitutes the gold standard in long-term prophylactic treatment. Appropriate therapy that prevents new episodes improves the disease’s course and reduces the frequency of harmful outcomes. Interestingly, preclinical data suggest that lithium has a (additional) neuroprotective effect. There is limited data on its related effects in humans and even less on its long-term application. In this multi-center cross-sectional study from the International Group for the Study of Lithium-treated Patients (IGSLi), we compared three groups: bipolar patients without long-term lithium treatment (non-Li group; <3 months cumulative lithium exposure, ≥24 months ago), bipolar patients with long-term lithium treatment (Li group, ongoing treatment ≥24 months), and healthy subjects (controls). Strict inclusion and exclusion criteria were defined; the inclusion criteria for patients were diagnosis of BD types I or II, duration of illness ≥10 years, ≥5 episodes in patient’s history and a euthymic mood state. Neurocognitive functioning was assessed using the Wechsler Adult Intelligence Scale-Revised (WAIS-R), the California Verbal Learning Test (CVLT), and a visual backward masking (VBM) task. A total of 142 subjects were included, 31 in the non-Li and 58 in the Li group, as well as 53 healthy controls. Treated patients with long-standing BD and controls did not differ significantly in overall cognitive functioning and verbal learning, recall, and recognition; regardless of whether lithium had been part of the treatment. Patients, however, demonstrated poorer early visual information processing than healthy controls, with the lithium-treated patients performing worse than those without. Our data suggest that bipolar patients with a long illness history and effective prophylactic treatment do not reveal significantly impaired general cognitive functioning or verbal learning and memory. However, they are worse at processing early visual information. Accompanying volumetric and spectroscopic data suggest cell loss in patients not treated with lithium that may be counterbalanced by long-term lithium treatment.http://www.journalbipolardisorders.com/content/2/1/16
Andrea PfennigMartin AldaTrevor YoungGlenda MacQueenJanusz RybakowskiAleksandra SuwalskaChristian SimhandlBarbara KönigTomas HajekClaire O¿DonovanDirk WittekindSusanne von QuillfeldtJana PlochCathrin SauerMichael BauerInternational Journal of Bipolar Disorders 2014, null:162014-12-24T12:00:00Zdoi:10.1186/s40345-014-0016-7/content/figures/s40345-014-0016-7-toc.gifInternational Journal of Bipolar Disorders2194-7511${item.volume}162014-12-24T12:00:00ZXMLLithium for prevention of mood episodes in bipolar disorders: systematic review and meta-analysisBackground:
In a previous meta-analysis of randomized controlled trials comparing lithium with placebo as a long-term treatment in bipolar disorders, we observed a clear preventative effect for manic episodes; however, the effect was equivocal for depressive episodes. Since then, the evidence base has grown further. In this update, we furthermore present the data on efficacy of lithium in comparison to alternative drug treatments. In addition, we analyze the data comparing lithium with placebo and other treatments regarding drop-outs due to reasons other than a mood episode and completion of study (no mood episode and no drop-out to reasons other than a mood episode).
Methods:
Randomized controlled trials (RCTs) were sought comparing lithium with placebo and lithium with an alternative treatment in bipolar disorders where the stated intent of treatment was prevention of mood episodes. To this purpose, the Cochrane Central Register of Controlled Trials (CENTRAL) was searched. Reference lists of relevant papers and major textbooks of mood disorders were examined. Authors, other experts in the field, and pharmaceutical companies were contacted for knowledge of suitable trials, published or unpublished.
Results:
For the comparison of lithium with placebo, seven trials (1,580 participants) were included. Lithium was more effective than placebo in preventing overall mood episodes (random effects RR 0.66, 95% CI 0.53 to 0.82), manic episodes (random effects RR 0.52, 95% CI 0.38 to 0.71), and, dependent on the type of analyses applied, depressive episodes (random effects RR 0.78, 95% CI 0.59 to 1.03; fixed effect RR 0.73, 95% CI 0.60 to 0.88). Lithium was inferior to placebo in leading to drop-outs for reasons other than a mood episode (random effects RR 1.33, 95% CI 1.07 to 1.65) but superior to placebo on study completion (random effects RR 1.69, 95% CI 1.12 to 2.55).For the comparison of lithium with anticonvulsants, seven trials were included (n = 1,305). In prevention of manic episodes, lithium showed superiority compared to anticonvulsants (random effects RR 0.66, 95% CI 0.44 to 1.00). However, there was no significant difference regarding prevention of overall mood episodes, depressive episodes, dropping-out to reasons other than a mood episode, or study completion.
Conclusions:
The evidence base for lithium in the long-term treatment of bipolar disorders has strengthened. With no other drug available having such ample and consistent evidence for its efficacy lithium remains the most valuable treatment option in this indication.http://www.journalbipolardisorders.com/content/2/1/15
Emanuel SeverusMatthew TaylorCathrin SauerAndrea PfennigPhilipp RitterMichael BauerJohn GeddesInternational Journal of Bipolar Disorders 2014, null:152014-12-20T12:00:00Zdoi:10.1186/s40345-014-0015-8/content/figures/s40345-014-0015-8-toc.gifInternational Journal of Bipolar Disorders2194-7511${item.volume}152014-12-20T12:00:00ZXMLLithium as add-on to quetiapine XR in adult patients with acute mania: a 6-week, multicenter, double-blind, randomized, placebo-controlled studyQuetiapine extended release (XR) and lithium are treatments with proven efficacy in acute mania. This randomized study evaluated the efficacy and safety of lithium or placebo as add-on to quetiapine XR in adult patients with manic or mixed symptoms of bipolar I disorder. In this 6-week, double-blind study (Trial D144AC00003), adult patients with DSM-IV-TR-diagnosed bipolar I disorder (current episode manic or mixed), a Young Mania Rating Scale (YMRS) total score ≥20, and score ≥4 on two of four core YMRS items were administered quetiapine XR (400 to 800 mg/day) and randomly assigned to receive add-on lithium (600 to 1,800 mg/day) or placebo. The primary efficacy end point was change in the YMRS total score from baseline to day 43, analyzed using a mixed-model for repeated measures (MMRM) approach. Secondary efficacy and safety end points were also measured. Rating scales were administered by trained staff. Three hundred fifty-six patients treated with quetiapine XR were randomized to add-on lithium (n = 173) or placebo (n = 183). Two hundred ninety-one patients (81.7%) completed the study. At day 43, least squares mean change in YMRS total score was −22.8 for add-on lithium and −20.1 for add-on placebo, a statistically significant treatment group difference of −2.69 (p < 0.001). On secondary measures, add-on lithium was associated with significant improvements in response, remission, illness severity, and overall illness versus add-on placebo (p < 0.05). The number needed to treat was 9.1 for response and 7.9 for remission for add-on lithium compared with add-on placebo. Lithium in combination with quetiapine XR was generally well tolerated, with a similar profile to quetiapine XR in combination with placebo. The addition of lithium to quetiapine XR therapy was associated with significantly greater efficacy than placebo as add-on and was generally well tolerated in patients with acute bipolar I mania. This study was registered under Clinicaltrials.gov Identifier NCT00931723.http://www.journalbipolardisorders.com/content/2/1/14
Michel BourinEmanuel SeverusJuan SchronenPeter GassJohan SzamosiHans ErikssonHongally ChandrashekarInternational Journal of Bipolar Disorders 2014, null:142014-11-08T12:00:00Zdoi:10.1186/s40345-014-0014-9/content/figures/s40345-014-0014-9-toc.gifInternational Journal of Bipolar Disorders2194-7511${item.volume}142014-11-08T12:00:00ZXMLEvery reason to discontinue lithiumLithium as a gold standard therapy for bipolar disorder is well known to have a number of medical comorbidities that impact renal, parathyroid, and thyroid function. Despite these medical comorbidities, there remains a group of lithium-responsive lithium-treated patients who have maintained mood stability for decades. The risk/benefit ratio of end organ toxicity/mood stability must be evaluated in each individual case.http://www.journalbipolardisorders.com/content/2/1/12
Manuel SalgadoBruce SutorRobert AlbrightMark FryeInternational Journal of Bipolar Disorders 2014, null:122014-11-08T12:00:00Zdoi:10.1186/s40345-014-0012-y/content/figures/s40345-014-0012-y-toc.gifInternational Journal of Bipolar Disorders2194-7511${item.volume}122014-11-08T12:00:00ZXML